Title: The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv
1The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Methamphetamine Problems Development of Native
Prevention Models
Dale Walker, MD Patricia Silk Walker, PhD
Michelle Singer Laura Loudon, MS Doug
Bigelow, PhD July 24, 2007
Phoenix, Arizona
2Native Communities
Advisory Council / Steering Committee
One Sky Center
3One Sky Center Partners
Tribal Colleges and Universities
Cook Inlet Tribal Council
Alaska Native Tribal Health Consortium
Prairielands ATTC
Red Road
Northwest Portland Area Indian Health Board
One Sky Center
Harvard Native Health Program
United American Indian Involvement
Jack Brown Adolescent Treatment Center
National Indian Youth Leadership Project
Tri-Ethnic Center for Prevention Research
Na'nizhoozhi Center
4Presentation Overview
- Whats the story on methamphetamine?
- Discuss prevention theory and models
- Integrated care approaches and interagency
coordination are best overall solutions
5Methamphetamine Abuse Eastward Movement Based on
Hospital Admissions
6Arizona Methamphetamine Admissions
Governors Council on Addictions 2006
7Oregon Methamphetamine Admissions
8OHSU Substance Abuse Clinic Enrollees
9National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
10National Methamphetamine Initiative Survey
Mark Evans Tactical Intelligence Supervisor New
Mexico Investigative Support Center 4-12-2006
11Methamphetamine Epidemiology
12Methamphetamine Use in 2004
Percentage
Source SAMHSA 2004 NSDUH.
13IHS-Wide Outpatient Encounters for Amphetamine
Related Visit by Calendar Year
14Lifetime, Past Year, and Past Month
Methamphetamine Use
Richard Kopanda, CSAT
a Significant change 2003 to 2004 b
Significant change 2002 to 2004
15 Why is Methamphetamine so Devastating?
- Cheap, readily available
- Stimulates, gives intense pleasure
- Damages the users brain
- Paranoid, delusional thoughts
- Depression when stop using
- Craving overwhelmingly powerful
- Brain healing takes up to 2 years
- We are not familiar with treating it
16Native Adolescents Multiple Life Risks
Psychiatric Illness Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance Use/Abuse
Hopelessness
Family Disruption Domestic Violence
CHILD
Family History
Negative Boarding School
Psychodynamics/ Psychological Vulnerability
Historical Trauma
Suicidal Behavior
17Adolescent Problems In Schools
Alcohol Drug Use
Fighting and Gangs
Bullying
Weapon Carrying
School Environment
Sale of Alcohol and Drugs
Sexual Abuse
Unruly Students
Truancy
Attacks on Teachers Staff
Domestic Violence
Drop Outs
12
18Methamphetamine, Why Now?
- The Internet
- Diffused local production, less reliance on
imports - Multi-drug use no one uses only crystal
- National outbreak
- Varied sub-populations
- More smoking
- Strong association with HIV, hepatitis C
- Community level responses to AIDS deaths, 9/11,
war - National discussion
19The Methamphetamine Effect
20Difficulties of System Integration
- Separate funding streams and coverage gaps
- Agency turf issues
- Different philosophies
- Lack of resources
- Poor cross training
- Consumer and family barriers
21(No Transcript)
22Developmental Paths for Multi-Problem Behavior
Dennis D. Embry
23The Intervention Spectrum for Behavioral
Disorders
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Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
24Prevention Theory
- Explains the causes and mechanisms of
action - Identifies the variables influencing these
- mechanisms, including cultural
- Predict points to interrupt the course
leading to - substance abuse and Specifies the
interventions to prevent the onset of - substance abuse.
25Theories of Prevention
- Cognitive-Affective
- Social Learning
- Intrapersonal
- Comprehensive
26Cognitive-Affective
- Theory The consequences of experimenting with a
drug contributes to decision to use. - Intervention Increase beliefs about negative
consequences of drugs, highlight benefits of not
using drugs, and correct inflated estimates or
perceptions of drug use.
27Social Learning
-
- Theory Adolescents acquire their beliefs
about substance use and other delinquent
behaviors from their role models, friends, and
parents. - Intervention Provide adolescents with
positive role models, and to teach them refusal
skills and the belief that they can resist drugs.
28Conventional Commitment and Social Attachment
- Theory Emotional attachments adolescents have
with peers who use substances is the cause of
substance use. - Intervention Improve bonds between
adolescents and positive peer groups and
prosocial institutions. Focus on improving
academic and career skills, provide career
opportunities, and teach parents how to socialize
and reinforce their children.
29Intrapersonal
- Theory Examine how personality
characteristics, emotions, and behavioral skills
contribute to substance use. Examples stress at
school, self-esteem, social interaction skills,
coping skills, and emotional distress. -
- Interventions Target many of the individual
characteristics of children rather than focusing
on their beliefs about specific drugs and
behaviors.
30Comprehensive
- Combines components from all of the other
theories. They attempt to account for how
adolescents' biology, personality, relationships
with peers and parents, and culture or
environment interact to cause drug use.
31Conclusions Before selecting an approach,
consider the following
- Who are the people in the support system?
- Are they contributor to the adolescent's level of
risk for using substances? - What are the adolescent's attitudes toward
specific substances? - How might values communicated through an
adolescent's culture influence decisions to
experiment with substances? - What are the personality characteristics,
emotional states, and/or behavioral skills of
adolescents at risk for using substances?
32Ecological Model
Individual
Peer/Family
Society
Community/Tribe
33Individual Intervention
- Identify risk and protective factors
- counseling
- skill building
- improve coping
- support groups
- Increase community awareness
- Access to hotlines other help resources
-
34Effective Family Intervention Strategies
Critical Role of Families
- Parent training
- Family skills training
- Family in-home support
- Family therapy
Different types of family interventions are used
to modify different risk and protective factors.
35Community Driven/School Based Prevention
Interventions
- Public awareness and media campaigns
- Youth Development Services
- Social Interaction Skills Training Approaches
- Mentoring Programs
- Tutoring Programs
- Rites of Passage Programs
36Risk Factors
- Exist in multiple domains.
- The more risk factors present, the greater the
risk. - Reducing the overall number can have a
significant impact on future problem behaviors. - Show the same effect across different races,
cultures and classes. - Can be buffered by protective factors.
37Protective Factors
Individual is given
- the opportunity for involvement in productive,
pro-social roles in family, friends, community,
society - the skills to be successfully involved in
those roles - recognition and reinforcement for their
involvement
38Prevention Programs Reduce Risk Factors
- ineffective parenting
- chaotic home environment
- lack of mutual attachments/nurturing
- inappropriate behavior in the classroom
- failure in school performance
- poor social coping skills
- affiliations with deviant peers
- perceptions of approval of drug-using behaviors
39Prevention Programs Enhance Protective Factors
- strong family bonds
- parental monitoring
- parental involvement
- success in school performance
- pro social institutions (e.g. such as family,
- school, and religious organizations)
- conventional norms about
- drug use
40Prevention Programs Should . . . .
Target all Forms of Drug Use
. . .and be Culturally Sensitive
41 WHAT ARE SOME PROMISING STRATEGIES?
42Integrated Treatment
- Premise treatment at a single site, featuring
coordination of treatment philosophy, services
and timing of intervention will be more effective
than a mix of discrete and loosely coordinated
services - Findings
- decrease in hospitalization
- lessening of psychiatric and substance abuse
severity - better engagement and retention
- (Rosenthal et al,
1992, 1995, 1997 Hellerstein et al 1995.)
43Comprehensive School and Behavioral Health
Partnership
- Prevention and behavioral health
programs/services on site - Handling behavioral health crises
- Responding appropriately and effectively after an
event occurs
44Treatment Approaches Effective withMethamphetamin
e Use Disorder
- Motivational Interviewing - MI
- Therapeutic Use of Urinalysis
- Contingency Management (motivational incentives)
- Community Reinforcement Approach
- Cognitive Behavioral Therapy - CBT
- Matrix Model (combination of above)
(Data show that methamphetamine treatment
outcomes are not very different than those for
other addictive drugs)
45Partnered Collaboration
Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
46Potential Organizational Partners
- Law Enforcement
- Juvenile Justice
- Medical Examiner
- Faith-Based
- County, State, and Federal Agencies
- Student Groups
- Education
- Family Survivors
- Health/Public Health
- Mental Health
- Substance Abuse
- Elders, traditional
47Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org